Bladder, ureter & renal pelvis

Cystitis

Polypoid / papillary cystitis



Last staff update: 28 November 2022 (update in progress)

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PubMed Search: Polypoid papillary cystitis

Maria Carolina Beeter, M.D.
Y. Albert Yeh, M.D., Ph.D.
Page views in 2021: 9,075
Page views in 2022 to date: 9,768
Cite this page: Beeter MC, Yeh YA. Polypoid / papillary cystitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/bladderpolypoidcystitis.html. Accessed December 1st, 2022.
Definition / general
  • Exophytic polypoid to papillary structures characterized histologically by normal or mildly hyperplastic urothelium overlying a congested, chronically inflamed and edematous stroma (Arch Pathol Lab Med 2012;136:721)
Essential features
  • Exophytic bullous, polypoid or papillary structures covered by benign urothelium and composed of stromal cores with varying degree of edema, vascular ectasia, congestion, inflammatory infiltrate and fibrosis (Am J Surg Pathol 1988;12:542)
  • Dense fibrosis with chronic inflammation in older polypoid cystitis (Surg Pathol Clin 2008;1:129)
Terminology
ICD coding
  • ICD-10:
    • N30.20 - other chronic cystitis without hematuria
    • N30.21 - other chronic cystitis with hematuria
Epidemiology
Sites
Pathophysiology
  • Injury and inflammatory irritation to the urothelium leading to chronic inflammation and reactive changes
  • Edema of the lamina propria
  • Inflammation and fibrosis of the lesion in chronic phase (papillary cystitis) (Surg Pathol Clin 2008;1:129)
Etiology
  • Catheterization: occurs in more than 80% of patients with indwelling catheters (Acta Pathol Microbiol Scand A 1979;87A:179)
  • Vesical fistulae: fistulae between the urinary bladder and the gastrointestinal tract
  • Radiation therapy for bladder, prostate or gynecologic cancer
  • Stones
Clinical features
  • Urinary frequency, urgency, dysuria, hematuria, bladder obstruction
  • Pneumaturia and fecaluria in patients with vesico-intestinal fistula (Br J Surg 1964;51:644)
  • Associated with vesical fistulae resulting from Crohn's disease, colonic diverticulitis, colon cancer or appendicitis (Urology 1979;13:115)
Diagnosis
Radiology description
Radiology images

Images hosted on other servers:

Irregular wall thickening

Prognostic factors
  • Catheter associated lesions regress within 6 months of removal of the indwelling catheter (J Urol 1983;130:456)
  • In non-catheter associated lesions, no recurrence in 6 months to 2 years after initial diagnosis (Int Urol Nephrol 2002;34:293)
  • No increased risk for progressing to carcinoma
Case reports
Treatment
  • Removal of the indwelling catheter for catheter associated polypoid cystitis (J Urol 1983;130:456)
  • Removal of the irritating agent
Clinical images

Images hosted on other servers:

Tumor-like lesion

Gross description
Microscopic (histologic) description
  • Variable exophytic lesions: bullous (width > height), polypoid (broad based, width < height) or papillary (narrow based, width < height)
  • No simple or complex branching of papillae
  • Stromal cores with varying degree of edema, vascular ectasia with congestion, acute and chronic inflammatory infiltrate and fibrosis
  • Overlying urothelium may be normal, metaplastic (squamous or mucinous) or hyperplastic (Am J Surg Pathol 1988;12:542)
  • Reactive urothelial atypia may be present
  • Dense fibrosis with chronic inflammation in older lesions (Surg Pathol Clin 2008;1:129)
Microscopic (histologic) images

Contributed by Maria Carolina Beeter, M.D. and Y. Albert Yeh, M.D., Ph.D.
Polypoid mass

Polypoid mass

Inflammatory polypoid lesion

Inflammatory polypoid lesion

Nonneoplastic polypoid lesion

Nonneoplastic polypoid lesion

Polypoid lesion

Polypoid lesion

Small cobblestone nodule

Small cobblestone nodule


Small polypoid nodule

Small polypoid nodule

Fibrotic lamina propria

Fibrotic lamina propria

Somewhat fibrotic stroma

Somewhat fibrotic stroma

Polypoid papillary projections

Polypoid papillary projections

Edematous polypoid lesion

Edematous polypoid lesion


Narrow to broad based papillae

Narrow to broad based papillae

Focal urothelial hyperplasia

Focal urothelial hyperplasia

Bullous lesion

Bullous lesion

Normal urothelial lining cells

Polypoid and papillary configuration

Polypoid and papillary configuration

Electron microscopy description
  • Pleomorphic microvilli present on surface epithelial cells in patients with catheter associated polypoid cystitis (J Urol 1984;131:242)
Sample pathology report
  • Urinary bladder, posterior wall, biopsy:
    • Polypoid / papillary cystitis (see comment)
    • Comment: The bladder lesion biopsy shows a polypoid lesion with focal finger-like papillae lined by benign urothelium. There is marked edema of the lamina propria. Dilated capillaries and rare lymphocytes are noted. Muscularis propria is not identified. These changes are consistent with polypoid / papillary cystitis.
Differential diagnosis
Board review style question #1

    A 65 year old man presents with intermittent hematuria. He has a history of indwelling catheter use. His cystoscopy shows a small exophytic lesion, which is biopsied. The histologic image is shown above. What is the diagnosis?

  1. Noninvasive papillary urothelial carcinoma, low grade
  2. Polypoid cystitis
  3. Urothelial carcinoma in situ
  4. Urothelial papilloma
Board review style answer #1
B. Polypoid cystitis

Comment Here

Reference: Polypoid / papillary cystitis
Board review style question #2

    A 64 year old man presented with dysuria and hematuria. Cystoscopic examination showed a 5 mm mass arising in the posterior bladder wall. Transurethral bladder tumor resection was performed. A histopathological image is shown above. What is the diagnosis of this lesion?

  1. Noninvasive papillary urothelial carcinoma, low grade
  2. Polypoid / papillary cystitis
  3. Urothelial neoplasm of low malignant potential
  4. Urothelial papilloma
Board review style answer #2
B. Polypoid / papillary cystitis

Comment Here

Reference: Polypoid / papillary cystitis
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